Deep Vein Thrombosis
Deep vein thrombosis (DVT) is a clot that forms in a large, deep vein of the legs, pelvis, or arms.
The primary concern with DVT is that the clot or parts of it can break free and travel along the veins through the heart and into the arteries leading to the lung. This is called a pulmonary embolus (PE) and can be fatal.
In fact, it is a significant cause of sudden death, particularly among hospitalized patients and others at risk for developing DVT.
The mainstay of treating DVT is anti-clotting drugs or “blood thinners” in order to prevent more clot from forming. Vascular surgeons are commonly called upon in certain instances when the clots are large and extensive enough to cause severe symptoms in the limbs or when protection from a PE is needed.
Do I Have DVT?
Symptoms are often acute or sudden in onset. They may include:
- Leg or arm swelling
- Bluish hue to the leg or arm
- Pain or tenderness in the muscles of the leg or arm
- Sharp chest pain made worse with deep breathing
- Shortness of breath
Common Risk Factors
- Recent surgery or trauma
- Prolonged bedridden or immobile status
- Past history of DVT
- Family history of DVT (congenital hypercoagulable state)
- Estrogen therapy (birth control or replacement therapies)
- Congenital anatomical abnormalities
- Lengthy travel
The first line test is a thorough history and physical exam to ascertain a DVT or PE from other more or less life-threatening conditions.
Initial tests include:
- Ultrasound of the legs or arms
- Chest x-ray
- Blood work
If we discover a DVT, it is important to identify the cause and initiate prompt treatment. This usually involves medications that are blood thinners that prevent further clot formation – they do not break down established clot. Your body’s own natural system will do that over time.
However, as the clot breaks down it can cause unintended damage to the lining of the veins and the valves that control venous blood flow. If this occurs patients can develop a condition known as “post-thrombotic syndrome.” This condition can cause chronic, severe limb swelling, pain, discoloration, varicose veins, and skin damage to the affected limb.
Patients who have DVT that involve the very large veins of the thigh extending up into the pelvis seem to be at highest risk of developing this complication.
To prevent this complication, we might perform the following treatments:
These stockings help control the swelling and pain from swelling by preventing blood pooling in the limb. This forces blood back into circulation and aids in clot breakdown.
We recommend starting compression therapy after appropriate medications have been started and there is no concern for spreading of the clot.
Venous Thrombolysis and Stenting
This is a catheter based, minimally invasive method of accelerating clot removal. It requires insertion of a catheter into a vein below the clot and the use of specialty catheters. These catheters can either inject powerful clot-busting drugs into the clot itself, break up the clot with wires, ultrasound waves or small jets of saline, or use suction to extract the clot.
Vena Cava Filter Placement
In some instances your surgeon may recommend placement of a filter, which acts like a “trap,” to block clots from travelling up to your lungs (a PE). This is a minimally invasive procedure that we do under a local anesthetic.
We place a catheter in a vein that we advance into the vena cava – the large vein in your abdomen that both of your leg veins drain into on their way to the heart and lungs. The filter looks a lot like an umbrella with no fabric, so normal blood can flow past, but the filter will trap large clots so your body can break them down.
Many times these filters are removable and we can remove them when the concern for a PE has lessened. The decision to place and/or remove a filter depends on several factors that we will discuss with you.